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Wednesday, January 11, 2017

The 10 Worst Medications for Your Kidneys

Dr. Sharon Orrange

Did you know that there are certain medications out there that can cause forms of kidney damage? Don’t get me wrong, these medications can be life altering, and even life saving – but they are known to directly affect kidney function.

Medications that can damage the kidneys are known as “nephrotoxic medications.” These drugs can cause direct toxicity to the kidneys, and have been implicated in up to 25% of acute kidney injuries. For people with even mild renal failure, you might want to think twice (or talk to your doctor) before you take these medications.

NSAIDS, or nonsteroidal anti-inflammatory drugs, lead the list for medication induced kidney damage because of their widespread use. NSAIDS are used to treat a host of conditions such as fever, rheumatoid arthritis, menstrual pain, and inflammation among many others. Use of NSAIDS like ibuprofen, naproxen, Motrin, Aleve, and Advil can reduce the amount of blood flow to the kidneys, resulting in a higher risk for kidney damage or failure. People with heart failure, liver disease, or previous kidney problems are at even higher risk when taking NSAIDS. To reduce the amount of risk associated with NSAID use, try to use these medications at the lowest effective dose for the shortest period of time.

Vancomycin is an antibiotic used for the treatment of severe methicillin resistant staphylococcus aureus (MRSA) infections. Vancomycin has been known to cause kidney damage, and acute interstitial nephritis, or swelling in the kidney. When taking vancomycin, your levels should be closely monitored to help avoid kidney injury.

Diuretics, sometimes called water pills, help your body release excess salt and water. These medications treat symptoms like blood pressure, glaucoma, and edema. There are three main types of diuretics: thiazide diuretics, loop diuretics, and potassium-sparing diuretics. Many diuretics affect how the kidneys regulate water in the body, which can lead to worsening kidney function and abnormal electrolytes. Talk to your doctor about what medications might be best for your kidney.

Iodinated Radiocontrast. Although this sounds like a complicated term, iodinated radiocontrast refers to any diagnostic test that contains dye, such as a CT scan with contrast. Contrast-induced kidney damage is a well-known complication of iodinated radiocontrast agents. It is one of the most common causes of kidney injury among hospitalized patients, occurring within 24-48 hours after receiving an IV contrast injection.

ACE Inhibitors can be good and bad for your kidneys. These are medications that tend to end in “-il,” like Lisinopril, Enalaril, and Ramipril. ACE inhibitors are usually used for high blood pressure, and heart failure. In certain cases, ACE inhibitors can result in a decline in kidney function when first started, and should be especially avoided in dehydrated patients. If you have kidney impairment, start on a low dose of ACE inhibitors, and ask your doctor about routine blood tests for creatinine. Interestingly enough, ACE inhibitors have been thought to be “kidney protective” for most diabetics, and do not cause worsening kidney function.

Jardiance (empagliflozin) is a new diabetes medication which has been reported to cause kidney failure. Importantly, Jardiance has diuretic effects and interacts with other nephrotoxic drugs (on this list) making the effects worse. Rare, but it can happen.

Aminoglycoside Antibiotics. This class of antibiotics are well known for causing kidney injury (nephrotoxicity), even at low doses. People with chronic kidney disease, dehydration, or those who have been taking these antibiotics for a long time are at particularly high risk. The most toxic aminoglycoside is neomycin, followed by gentamicin, tobramycin, amikacin, and streptomycin being the least toxic. Although these medications are typically intravenous and used in hospitals, they are important to keep at the back of your mind!

HIV medications/antiretrovirals. Certain antiretroviral medications are associated with chronic renal impairment, and can increase your risk for kidney disease. Viread (tenofovir) and Retataz (atazanavir) have both been shown to cause acute tubular injury.

Zoledronate (Zometa, Reclast). These drugs are typically used to treat osteoporosis, and can cause tubular cell toxicity and kidney failure. Given as an IV infusion for cancer bone metasteses, Zometa carries a well-established risk of deterioration of kidney function.

Foscarnet. This drug is a rarely prescribed antiviral, used for viral reactions in immunocompromised patients. It is a highly nephorotoxic drug, which causes injury to the tubules in the kidneys.

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